This paper will document the formation of the Australian Lesbian Medical Association (ALMA), and some of the stories of discrimination told by women within the safety of this group. It will then touch on some of the international literature regarding discrimination experienced by sexuality minorities within medicine. We will present the early data collected from the first ALMA membership survey, which is still underway. Finally, we will present a model for empowerment of these doctors that is emerging through ALMA.

Our reality

An ALMA member weeps as she speaks of wondering whether she can keep facing the hospital training. She is in a male dominated specialty. Her lesbianism remains invisible, but she is attacked for her feminist way of being in the world. She is the brunt of jokes and insulting comments. She is elbowed out of certain training opportunities, these instead being given to a male colleague. Her record of handling certain procedures is far above average, but that doesn’t seem to count. She attends an ALMA conference, and the support in the room for her pain and courage is palpable. She is urged by some to continue, as women in this area are desperately needed. Others offer emotional support through email or phone.

Another member talks of the loneliness of realizing she was gay as a medical student, and looking up Homosexuality in Harrison’s one study session, and finding it was in the same category as Alcoholism and Paedophilia.

An Australian initiative creating support for lesbians in medicine - formation

The Australian Lesbian Medical Association grew out of the personal need of individual lesbian doctors to connect with each other for professional support.

Two lesbian doctors who had not previously met decided, during a telephone conversation, to have a coffee together. They both had a long-held dream about the possibility of a lesbian doctor’s professional association and together decided to have national conference. Two other doctors were co-opted onto the “Committee for the First Annual Australian National Lesbian Doctors Conference”. A venue (with the capacity to seat from 6 to 60) was booked. A flyer containing a conference program was created. At the time the flyer was printed, the program existed almost entirely in the imagination of its creators. The flyer was disseminated from woman to woman. A few brave doctors also left it on coffee tables and posted it on walls. The conference took place in a nurturing, waters-edge environment on the east coast of NSW in July 1999. A total of 30 women attended. The association was born.

From the first meeting of this group of doctors that was to become ALMA, there was a strong feeling of freedom between the members to say things where they had remained silent. Previously, many women had not revealed their experiences of homophobia for fear of not being understood, or worse, in the case of those who were employed, of losing their hard-won hospital training positions. Speaking up meant the possibility of having to handle ridicule, or even retaliation, in much the same way as occurs with racism. However, in the case of homosexuality, the individual often can choose to stay invisible, which creates protection of sorts, but has its own cost in the sense of isolation that results.

It was clear from the outset that the connecting with each other made a difference. In the feedback after the first conference one woman who had practiced medicine successfully for many years wrote “Thank you…many of us have been longing for this for years. I’m so sick of not really enjoying, not feeling part of, not really into most of the topics of the usual doctors conferences….this weekend has provided inspiration and energy to go on…”

Others wrote or spoke of their feelings of alienation and isolation in relation to the mainstream medical world. Some doctors wrote of the importance of having role models. Many spoke of previously feeling like “…I was the only lesbian doctor in the universe.” They spoke of how different it was to realise that there were others with similar backgrounds facing similar challenges.

Lesbian doctor’s stories

At both the first and second conferences, those who had been on the receiving end of serious and career changing discrimination told painful and touching stories. Several spoke of eventually choosing not to proceed with the speciality of their choice after persisting and un-relenting harassment and discrimination. It was important for women to hear each other’s stories and to hear that they were not alone. It was also important for women to have the matters put into perspective. At the first conference, a partner who worked in a non-medical profession, after listening to women tell their stories got to her feet and said “Don’t you realise that you are talking about being abused. This is abuse.” The doctors present had not labelled it in that way. It had simply been seen as part of their professional environment.

One of the ALMA members, as an intern, experienced being at morning report when the medical registrar was presenting a case from the previous night. A woman had presented, having been hit by a heavy object, and it became apparent that the registrar discussing the case had not done a proper neurological examination. He was being taken to task for this, and in his defense began making a joke of it, saying the woman had been hit by her partner who was a another woman. The room of doctors began making ribald comments and jokes, and as one doctor tried to take the focus back to the case, an eminent cardiologist defended the medical registrar commenting along the lines of “Well, you could hardly expect him to touch her.” The ALMA member who tells this story, says she felt incapable of speaking up at the time.

Another doctor in general practice tells of being contacted by various young lesbian medical students, who were feeling the lack of role models for themselves. They reported homophobic comments from other students and in hospital situations. They did not feel safe in declaring their true selves and always kept part of their lives separate. They expressed the need for affirmation of themselves as lesbians who were about to enter the professional world of medicine, where they were only too well aware of the general homophobic attitudes of the institutions they would be working in. Another student tells of being in a Behavioural Sciences tutorial in1991 where one of the subjects for discussion was deviant behaviour and how to deal with it in a medical sense. Bestiality was discussed, then homosexuality. The discussion continued, and the young student began defending homosexuality as a behaviour that should not be considered deviant. She described it as “a traumatic afternoon for me…retreating to ..the back of the discussion group.”

Another doctor reports of having to stand in an operating theatre and listen to a urologist put forward his theories of why gay men are deviants. And another time listening to senior colleagues scorn the anaesthetist next door because he was gay.

None of these situations have been life threatening to any of the doctors involved, but stories such as these are a part of many lesbian doctors’ lives. They are situations which intimidate, shame and push lesbian doctors out of certain work places. They illustrate that if a lesbian doctor is open in the same way as her heterosexual colleagues, she puts herself at risk for making her workplace difficult or even unbearable, and in some cases risks losing her job. In some countries the consequences of being identified as lesbian would most definitely be life threatening. We hope that the existence of ALMA, the Australian Lesbian Medical Association, will be of some support to lesbian doctors in these countries, as well as in Australia.

Experiences and effects of discrimination by sexuality minorities in medicine

Lesbian doctors and medical students face discrimination and homophobia within the medical system, which adversely affects their well-being. Fifty four percent of lesbian doctors and medical students in the USA have experienced discrimination within the medical profession as a result of their sexual orientation.1 This is predominantly due to negative attitudes and behaviour of colleagues. A 1986 survey of doctor’s attitudes showed that 30% doctors interviewed were opposed to admitting gays and lesbians to medical schools and 40% would not refer clients to gay or lesbian colleagues.2 A more recent study in New Mexico does show a positive shift in attitudes, with only 4.3% saying they would refuse gay and lesbian applicants admission to medical school.3 However, research carried out in 1993 in the United States involving 4501 female doctors showed that 41% of lesbian/bisexual doctors (n=156) experienced harassment related to their sexual orientation compared to 10% of heterosexual doctors (n=4177).4

consequence of experiences or fear of discrimination is non-disclosure and thus invisibility of their lesbian identity.5 Medical students are especially vulnerable to the affects of negative attitudes, as they are often just coming to terms with their sexuality and fear the consequences of disclosure within their course.6 Most lesbian and gay doctors report that they do not disclose their sexual orientation within their profession and that this is due to fear ostracism and of negative affects on their career progression.78 This creates a sense of discomfort in failing to be completely honest yet is weighed up against the need to maintain safety.9 Lesbian and gay medical students and residents attempt to match their selection of residency placement to one in which they will feel welcomed and respected, yet still fear discrimination if they come out.10 Their sexual orientation affects their choice of career path and a great deal of energy is expended “trying to find a balance between self-protection and self-disclosure” in that choice.11

A further factor that perpetuates the invisibility of lesbians within medicine is a lack of curricula content regarding lesbian and gay issues, which has been widely reported in the UK12, the USA1314 and Canada.15 A survey of 72 gay and lesbian medical students showed that these students wanted a more affirming study experience and wanted gay and lesbian issues to be addressed in all coursework.16

Australian lesbians in medicine – a survey

A survey is underway of lesbian doctors and medical students in Australia. This has been sent to 116 women who are on the mailing list of the Australian Lesbian Medical Association (ALMA). So far 40 (34.5%) lesbian doctors and medical students have responded. The survey is a 26-item questionnaire, asking sexuality identification, degree of disclosure within the profession, degree of social connectedness within and outside medicine, level of medical education received regarding lesbian and gay issues. Respondents are asked about the usefulness of various ALMA activities and finally about their experiences of harassment and discrimination as a result of their sexual orientation. It is returned anonymously.

Some items are compared with the same items used in the USA Gay and Lesbian Medical Association membership survey of 1994. In particular 18 women (45%) had experienced some form of discrimination within the medical profession (compared with 54% in USA), see table 1. The most common form this took was being socially ostracized by other doctors.

The level of harassment as a result of sexual orientation is seen in Table 2, with two thirds of respondents having experienced harassment in their personal life, and 10 % having been physically assaulted. The degree of harassment does partly correlate with the extent to which respondents have disclosed to colleagues, however degree to which they are ostracized does not- see Figure 1.

Improving well-being of sexuality minorities within medicine

Recommendations in the literature to improve the situation for this particular minority group in medicine are:

1. Develop guidelines on anti-discrimination that include sexual orientation

in medical school and health institution policy – for example in the UK only 10% of the medical schools have specific policies protecting medical students against discrimination18. The UK based Gay and Lesbian Association of Doctors and Dentists (GLADD) held a workshop on challenging workplace bullying and homophobia in the NHS and addressed the need for a national guideline addressing homophobia.19

2. Increase curricula content of lesbian and gay issues, in an integrated fashion, including specific areas of knowledge, skills for sensitive communication and positive attitudes towards lesbian and gay patients and colleagues.20212223 ALMA survey respondents were asked about their recollection of receiving education regarding lesbian and gay issues. Twenty-three (57.5%) had not, and of the 17 that had, only one recalled education within her workplace. Four recalled education within postgraduate training at an average of 2 hours each, and 15 received during undergraduate training at an average of 4 hours each. Regarding policy development by ALMA, 27 (67.5%) agreed. There were 15 comments provided, with 9 specifically suggesting policy on inclusion of lesbian issues in medical education.

3. Create support systems for lesbian and gay students and doctors

Medical faculties to support the development of lesbian and gay medical student groups in recognition of the specific issues faced24. A national survey of support services for gay students in US medical schools in 1990 showed that approximately half the medical schools had a specific support group.25 A repeat survey in 1994 showed that 70% had a support group and nine schools had an official liaison officer, compared with four in 1990.26

mentoring and role modelling within the profession for sexuality minorities, which particularly relies on the ability of lesbian and gay doctors to disclose their sexual orientation within their workplace.30 Of the 40 women responding to the ALMA survey, 33 indicated they were willing to be mentors to other lesbian medical students or doctors.

A model for empowering professional minorities

The presence of the organisation has changed lives. Marion, started her association with ALMA began saying that she did not want to acknowledge her connection with the organisation openly. Over time she has become comfortable with a visible role on the organisation’s steering committee. Stephanie wanted to help create the ALMA entry into Mardi Gras. At first she said she would help with behind the scene production of the entry. Then she said that she wanted to go in the parade, but would wear a wig and a mask. In the event, she marched proudly as herself!!

The membership of ALMA is extremely diverse. Individual members have a wide range of political views and economic backgrounds. Despite the diversity, these doctors have been empowered by their links with each other. The ALMA survey revealed that many respondents had developed new connections with other lesbian doctors and students as a result of joining the group- see Figure 2. It is also clear that very few respondents belong to other lesbian and gay organisations. Seeing other doctors living openly as lesbians and doing well professionally empowers others. It inspires courage. It is a demonstration that lesbian sexual identity and medical professionalism are not incompatible. In fact, the strong vibrant professional role models that now exist within ALMA are role models for professional excellence.

Members of ALMA have realised through our experience of establishing ALMA and on the needs expressed by members of our group that the organization is developing a model for empowerment. We see a several stage process in the formation of such a group, with each stage building on the previous, as group members gain in strength and affirmation of purpose. This has parallels with the six-stage process of ‘coming out’, developed by an Australian, Vivienne Cass that has been widely accepted as a model for gay identity formation. [Cass V 1984] Cass describes a process from identity confusion, to comparison, then tolerance, acceptance, pride and finally identity synthesis. From tolerance to synthesis, the process involves increasingly seeking social contact with other lesbians and an increasing commitment to the wider homosexual community. Identity synthesis recreates connections with the heterosexual community.

Our model is in the process of development and currently has the following stages:

Stage 1 – Individual connections

begins with enabling connection between individual lesbian doctors

Stage 2 - Networking

more advanced networking at a local, State and National level.

Stage 3 - Mentoring and role modeling

This reduces the sense of isolation and difference.

Stage 4 – Advocacy within medicine

As we gain strength from these connections, we also gain an ability to advocate improving the well being of lesbians within our profession.

Stage 5 – Advocacy within society

Finally, we develop a wider voice of advocacy, with a view to challenging heterosexist assumptions and homophobia. This will ultimately reduce the experiences of discrimination for lesbian consumers and doctors alike.

As each month passes new lesbian students and doctors join ALMA. The process of empowerment is gathering momentum on an individual and organsiational level. Members look forward with interest and excitement to the implementation of the model and subsequent reduction in experiences of discrimination for lesbian students and doctors.

Schatz B, O’Hanlan K. “Anti-gay Discrimination in Medicine: Results of a National Survey of Lesbian, Gay and Bisexual Physicians.” San Francisco: American Association of Physicians for Human Rights, 1994.

17 Schatz B, O’Hanlan K. “Anti-gay Discrimination in Medicine: Results of a National Survey of Lesbian, Gay and Bisexual Physicians.” San Francisco: American Association of Physicians for Human Rights, 1994.